Do oral ovulation induction agents offer benefits in women 38 to 43 years of age undergoing insemination cycles?

Abstract

ObjectiveTo compare the success of ovulation induction using oral agents versus gonadotropins (GTs) in women ≥38 years old. Study DesignA retrospective cohort study was performed including all first to third stimulated IUI cycles conducted after the age of 38 years in a single academic fertility center between 01/2011 and 03/2018. ResultsA total of 1596 IUI cycles were included. 240 cycles were with clomiphene citrate (CC), 176 letrozole cycles and 1180 gonadotropin (GTs) cycles. The GTs group were older (p < 0.001), had lower antral follicular count (p < 0.001), and thicker endometrium (p < 0.001) compared to the oral agent groups. The letrozole group had a less mature follicles (p = 0.004) at the time of triggering compared to the other groups. No difference in pregnancy or clinical pregnancy rates was observed after controlling for confounders when comparing the 3-groups. 5 multiple pregnancies occurred, all in the GTs group. The groups were subdivided by age; 38–39 years old (N = 750) and 40–43 years old (N = 846). Nevertheless, no statistical difference was observed in pregnancy rates and clinical pregnancy rates between oral agents and GTs when controlling for the confounding effects among women at age 38–39 (p = 0.47, p = 1.0; respectively) and among women 40–43-years-old (p = 0.16, p = 1.0; respectively). ConclusionsClearly costs of oral agents are lower and they are more patient friendly than GTs, therefore oral agents should be first line for ovarian stimulation and IUI in women 38–43-years of age.